Equipment to elicit frissons or aesthetic chills, through the multisensorial and multimodal stimulation; with the objective of relieving chronic pains and the method to use it

ABSTRACT

Equipment for self-care of patients with chronic pain, through inducing, intensifying and maintaining their own frissons and where multisensory and multimodal stimuli are used to achieve it; musical, visual, aromatic and vibrotactile and cold are applied on the cutaneous surface of the spine. In addition, the method for using them through perceptual learning is presented. The equipment consists of a computer and a computer system with a music and video player, lighting, presentation of aromas and a closed hydraulic circuit with a hydraulic actuator.

FIELD OF THE INVENTION

This invention provides the equipment and how to use it, for theself-care of patients with chronic pain, by inducing and/or intensifyingand/or maintaining their own frissons, by means of multisensory andmultimodal stimulations. Among the individual and social benefitsprovided by this invention is to improve the individual's, family andwork life of patients by decreasing the cost of medical treatments,without producing habituation and reducing adverse side effects.

INTRODUCTION

The ultimate goal of this invention is to make patients with chronicpain reassure that they are able to regain the ability to have it undercontrol, since ignorance about what is happening to them and feelings ofhelplessness exacerbate anxiety and fear. Holden R and Holden J. (2013).

The standard definition of chronic pain given by the InternationalAssociation for the Study of Pain is one that persists beyond normalpain for a tissue over time. In an arbitrary way a chronic pain has beendefined as that which lasts more than 12 weeks after a continuous acutepain. At a medical level the difference between acute and chronic pain,is that in which acute pain the goal of the treatment pointed to thecauses of it, while in chronic pain the goal is to direct attention toits effects in order to maximize the functionality and the patient'squality of life.

It is estimated that worldwide one thousand five hundred million peoplesuffer from chronic pain and that around 100 million north americanssuffer from it, with an important effect on the economy. In this lastcountry the loss of productivity attributable to this type of pain isestimated at around $299 and 325 billion annually, due among otherfactors to the lost work hours of the patient as wall as that of thepeople related to it.

According to Mills S. et at (2016), chronic pain is a common, complexand challenging condition, where to deal with it with good resultsrequires understanding the biological, social, physical andpsychological context of the individual. Simons L. et al (2014), arguethat chronic pain involves complex brain circuits that include sensory,emotional, cognitive and interoceptive processing, which in rigour is aanother pathology, since it causes changes in the nervous system thataggravate it (comorbidity) According to the bibliographic review theauthors Bushnell M. C. et al (2013), pain is a sensory and emotionalexperience that can vary widely among people, and even in theindividual, depending on the context and meaning of the pain and thepsychological state of the person. Cognitive and emotional factors, suchas anxiety and fear, have an important influence on the perception ofpain.

Pain can have negative effects on emotions and cognitive functions. Anegative emotional state can lead to an increase in pain, while apositive one can reduce it. Similarly, cognitive states such asattention and memory can increase or decrease pain. Certainly emotionsand cognition can interact with each other.

In general terms, the pain that affects patients with chronic pain canbe classified as:

-   -   Nociceptive pains: Pains whose etiology is an inflammation or        continuous peripheral damage. This type of pain may respond to        medications or procedures.    -   Neuropathic pains: Pains caused by trauma to the peripheral        nerves. This pain can respond to pharmacotherapy.    -   Central pains: This type of pain can be constant and goes from        moderate to severe and is due to damage in the CNS that causes a        sensitization of the pain system. This type of pain can respond        well to psychotropics and therapies without opioids.

Staff of the Mayo Clinic notes that the appropriate medications forchronic pain, and that are part of the treatments of conventionalmedicine, are the following (Steps I to II of WHO):

Type of medication How do they work Pains (Non Steroids Anti- Blockenzymes COX-1 y COX-2 Mild to moderate from swelling inflammatories)related with pain and inflamation. and inflammation. Arthritis, muscularsprains, neck and back injuries. Paracetamol or Probably they blockCOX-3 Mild to moderate pains Acetaominophen enzyme Selective inhibitorsof Probably they block COX-2 Rheumatoid arthritis, osteoarthritisCyclooxygenase enzyme and pain of injuries. Antidepressants They affectchemical processes Dolor neuropático, dolores de that cause pain. cabezacrónicos, fibromialgia y lumbalgia crónica Seizure drugs Relieve paincaused by damage Neuropathic pain, chronic to nerve fibers headaches,fibromyalgia and chronic low back pain Opioids Activateneurotransmitters, Acute pain such as post-operative endorphins, whichreduce pain or bone fractures. and increase well-being.

An alternative to the use of medications for chronic pain relief is theuse of neurostimulation therapies (WHO Step IV), which include invasiveand non-invasive methods. In those treatments, electromagnetic energy isapplied to specific anatomical targets to elicit the neurostimulation ofthe network of neural circuits. Authors Edwards C. et al (2017) made aliterature review in which they present three devices of this type ofapparatus; of deep stimulation of the brain, of motor cortex stimulationand of vagus nerve stimulation.

All these implantable systems include three primary components: theelectrode, the extension and the pulse generator. The electrode isimplanted in the target area, the extension subcutaneously connects theelectrode to the pulse generator, which also provides the electricalenergy (batteries) to the device. The pulses interfere and block theelectrical signals that cause the pain, an effect that is based on theGate Control Theory; of the authors Melzack R and Wall P. (1965).

Although pharmacological treatments have been used frequently for therelief of chronic pain, among others opiates ones, there is reluctanceto use them in the latter time in non-cancerous patients, due toproblems in their tolerance, dependence, addiction and its high costs.It's for these reasons that the interest in using integrative medicinalstrategies in the treatment of chronic pain has increased.

The authors Yuan-Chi Lin et al (2017), made a literature review, inwhich 1686 publications about integrative medicinal therapies could beidentified, for the treatment of chronic pain, which includesnutritional supplements, yoga, relaxation, Tai Chi, massage, spinalmanipulation, acupuncture and others.

The literature review shows evidence of a positive, although moderate,effect of yoga, of relaxation, of Tai Chi, massages and spinalmanipulation and a solid backing of acupuncture, as complementarymedicine, which reduces the use of opioids.

STATE OF THE ART Multisensorial and Multimodal Stimulation

According to Holmes N. et al (2009), multisensory stimulation refers tothe conbination of information from different sensory modalities (thefive classic ones: vision, hearing, touch, taste and smell), as well assome less obvious ones such as proprioeption, the kinesthetic, pain andvestibular sense, which gives rise to the changes associated with theperception and reception of those stimuli.

Laird D. (1985) observed that in learning, there is an asymmetry in theinformation provided by the senses, since most of the knowledge reportedby adults acquired it through vision (75%), through hearing (13%) and bythe remaining senses (12%). According to Sawkut R. (2010), it isunderstood that learning is a process by which a subject increases itsknowledge reserves and uses that knowledge to adapt to the environment.

When talking about multisensory stimulation, reference is made to theentry of information through the senses to elaborate sensations andperceptions, the first element on which learning is built, and whichinvolves the first stage of the development of basic cognitivefunctions, to which follows then the development of higher cognitivefunctions.

Multimodal perception deals with how at some point of perceptualprocessing, in which sensations are selected, organized and interpreted,in it information coming from various sensory modalities is integrated.According to Follman R. et al (2018), the information captured by thesenses is first integrated separately and then combined in variousmultimodal convergence zones, including the cortical and subcorticalregions and also in the multimodal association zones.

It has been shown that responses to an integral mutimodal stimuli aregreater than the sum of individual unimodal responses. Calvert et al(2004) demonstrated how stimuli that individually presented are weak andineffective can be combined in a superaditive way, giving rise to moreintense and rich multisensory experiences than the linear combination ofthe individual parts. Multimodal stimulation is often used in therehabilitation of patients who have had recent brain damage.

According to James K. et al (2018), the mechanisms that supportmultimodal-multisensory learning nowadays are is being betterunderstood, since they has multiple benefits, including theincorporation of isolated neural networks that then serve as a link tocreate more efficient adaptive systems.

The fact that interacting with the environment involves multisensory aswell as multimodal processing, makes that that interaction facilitateslearning in many other domains, including pain management, throughemotional regulation and understanding of cognitive processes. In thisinvention the multisensory and multimodal presentation of the followingtypes of stimuli and their responses is described: a) Music therapy, b)Visual stimuli, c) Vibrotactile stimuli, b) Cold therapy and c)Aromatherapy,

Music Therapy

According to the American Association of Musical Therapy (AMTA), musictherapy consists of using music in a therapeutic way, aimed at improvingthe functional physical, psychological, cognitive and/or social aspectsof patients. Furthermore, music therapy interventions can be designed topromote well-being, manage stress, relieve pain, express feelings,improve communication and promote physical rehabilitation. It is saidthat music is not only heard but felt in the body, which suggests thatthere are other senses involved in the experience, in addition tohearing, as well as proprioception, the vestibular system and/orcutaneous touch.

Music is differentiated by tone and timbre, however it's alsodistinguished by the processing of the sequence of notes, giving rise torhythm, tempo and metrics. Brochard. R. et al (2008) assumed that peoplecould not extract the structure of the metric, through vision andthrough light flashes, however through an experiment they were able todemonstrate that people were able to extract the metric from a tactilestimulation (tingling of the fingertips).

Huang J. et al (2013), did an experiment to demonstrate that the stimuliof the skin afferents that innervate the skin and the deep tissues ofthe body, contribute to the perception of the metric. The participantshad to discriminate between 2 sequences, one of 2 pulses (like themarches) and another of 3 (waltz). The stimuli were presented to them inthree different ways: 1) unimodal (hearing and touch separately), 2)Different combinations of bimodal inputs that were distributed betweenthe auditory and tactile channels and 3) Simultaneous bimodal inputs inwhich the two channels contained passwords metric congruent orincongruent.

Huang et al demonstrated first that the metric is well perceived, from70 to 85%, when the tactile or auditory keys were presented separatelysince in the bimodal inputs the tactile and auditory keys wereintegrated to produce percepts (products of artistic excellence) metriccoherent In addition, a high performance was observed, 70 and 90%, whenall the important notes of the metric were assigned to a single channeland reduced to 60% when half of the notes were assigned to the remainingone. By simultaneously presenting the notes in both channels, congruentkeys improved recognition by up to almost 90%. These results are thefirst demonstration of the cross-sensory perception and the mostprobable thing is that the metric comes from a single nervous path,which is fed with information from both systems, but where the auditoryinformation has a greater weight.

Music and Pain

A meta-analysis, regarding the effect of music on pain, made by Hyung J.(2016), included the results of 97 researches published between 1995 and2014, obtained from 12 databases and from other sources, and It yieldedthe following results:

-   -   Music decreased pain, by around 1.13 units, on a scale of 1 to        10.    -   The music had a moderate effect in reducing the levels of        analgesics, both opioids and non-opioids, during or after the        administration of the same.    -   The results showed a statistically significant effect that music        decreases heart and respiratory rates and systolic blood        pressure.    -   Hyung J. concluded that musical interventions are an effective        complementary medicine for the relief of pain, both acute and        chronic.

On the other hand the authors Garza-Villarreal et al (2017) argue thatalthough music is used increasingly for the management of chronic pain(efficient, low cost and non-invasive), but there are few clinicalbackgrounds on its application in patients with chronic pain, so theychose to do a literature review and a meta-analysis considering all thepublished studies that dealt with musical interventions for chronic painmade up to May 2016. (768).

Garza-Villaroel et al concluded that music decreased self-reported pain,anxiety and symptoms of depression, in conditions of chronic pain. Theyalso observed that self-selected music had a greater analgesic effectthan that offered by researchers. This would be the most completebibliographical review and meta-analysis, regarding the relationshipchronic pain music, made up to that date

The authors C. E. Dobek et al (2014) affirm that pain is a verysubjective experience that can be mitigated by listening to music andthat corresponds to a phenomenon known as music-induced analgesia. Therewould be abundant literature demonstrating that music can reduce stress,depression and anguish in people with acute or chronic pain, however itsmechanism of action has not yet been demonstrated, although it has beenobserved that pleasant emotions reduce pain and that the unpleasantincrease it. These results can not be explained only by the distractioneffect, since the negative emotional stimuli, although they also have adistracting effect, do not diminish the pain. Following this logic, theauthors studied the modulating effect in pain of positive and negativeemotional reactions of music.

The authors Roy M. et al (2008), maintain that the ability of music tocalm has been used in many traditional forms of medicine. As an example,they cite a pioneering work done with 5000 dental surgery patients,where 90% of them reported that the pain had been reduced with music.Another effect of the analgesic properties of music is to induce strongpositive emotions, since it has been observed that they improve mood andinfluence a wide range of cognitive abilities. Hence, emotionalreactions can be a key component in explaining music-induced analgesia.

In US patent 2010/0312042 A1 it is held that music therapy wasadministered by professional specialists to patients on an individualbasis, however the delivery of this therapy was limited by the number ofspecialists, especially in health institutions. In order to overcomethis limitation, they created a system and a method for administeringtherapeutic music contents individually, according to a prescribedsequence and according to the preferences of the patients and theschedules of the daily activities.

The CN 202822492U utility model discloses a multifunctional therapeuticelectromusical stimulation device that combines acupuncture, moxibustiontechnology (heating body points) and music therapy technology. Themultifunctional therapeutic apparatus comprises an output circuit, astorage unit, an audio decoder unit, a signal processing unit, a maincontrol unit, an A/D conversion unit, an audio amplification unit and avolume and power regulation unit and where the output circuit isconnected to a therapeutic electrode that is applied to the body throughpulses. The storage unit stores music files that are used according to atherapeutic prescription.

Music and Emotions

Jusin P. et al (2008), did a study to investigate emotional reactions indaily life, with and without music. To avoid the use of self-reports,participants were given notebooks that issued random warnings during theday, with each warning they had to report their situation and theiremotional state. When comparing the emotional states reported by theparticipants with or without daily music, the results revealed thattheir emotional states were more positive with the presentation ofmusic. The authors conclude that music induces emotions and that it canbe done on a daily basis.

Juslin P. and Vastfjall D. (2008), proposed 6 mechanisms, other thancognitive evaluation, through which music would induce emotions and thatare the following:

a) Reflexes of the brainstem when a loud and/or unexpected sound causesa reflex response, b) Evaluative conditioning, which occurs when a pieceof music is associated with an emotional event or object, c) Emotionalcontagion when the emotion expressed by music is internalized, d) visualimages evoked by music that can have an emotional connotation, e)episodic memory that is related to autobiographical events and f)frustration in the fulfillment of musical expectations.

Zentner M. and Grandjean D. and Scherer K. (2008), conducted severalexperiments using self-reports to examine the emotions most commonlyexperienced by the public during various musical events. In the third ofthose experiments, 2002 attendants to different types of concerts wererecruited to answer a questionnaire indicating which affective state,from a list of 65 possible ones, was the one they had perceived mostfrequently in the events. Of the 801 that returned their questionnaires,the affective state they had experienced most frequently was relaxation(44.6%), happiness (41.5%) and joy (39%), respectively. The last oneswere anger (with 2.4%), depression (2.7%) and distress (3.4%).

Based on this information, Zetner el al concluded that the excitationeffect of music can be differentiated empirically in many subunits (theydetermined 40 affective states), which grouped into 9 emotions: delight,nostagia, transcend, peace, tenderness, energy, joy, tension and sadnessand in 3 big factors, sublime, vitality and upset. In summary, it isconcluded that positive emotions are the most frequently experienced inmusical events.

Music and Emotion Regulation

Rolston A. and Lloyd-Richardson (2018), hold that emotional regulationis a term used to describe a person's ability to regulate the valence,intensity or duration of an emotional experience. According to Koole S.(2009), making use of emotional regulation people can Increase, maintainor mitigate positive or negative emotions.

Sena K. (2013), conducted a systematic review on emotional regulation(ER), which is an internal process in which the person maintains acomfortable state of excitement, while regulating one or more aspects ofthe emotion. The objectives of the literature review were to explore andsynthesize, what is known about how music and musical experiences impacton the neural structures related to ER. In addition to considering theimplications of these findings to structure the presentation of stimulithat facilitate ER; In short, find the way to use music to enhanceemotional regulation.

The results obtained by Sena indicate that there are certain musicalcharacteristics and experiences that cause patterns of desired andunwanted neuronal activation related to ER. The desired activationpatterns occur when listening to favorite and familiar music and alsowhen singing and in the musicians when improvising. Unwanted activationpatterns arise when complex, dissonant and unexpected musical eventsoccur.

Various techniques have been used to evaluate the regulation of emotionssuch as self reports, neuroimaging and psychophysiological measurements,however studies have been limited by the number of strategies used;where by emotion regulation strategy is understood the way to manipulatethem. The strategies generally used in the various studies in thisregard are those formulated by Gross J. and Thompson R. (2007):Selection of the situation, development of skills, distraction,breathing, emotional expression, social support and suppression ofemotions. Other authors suggest that individuals may have a greaternumber of strategies to choose and match them within a given context.

The authors Verduyn P. and Lavrijsen S. (2015), point out that emotionsare dynamic processes that change over time. A determining feature ofemotions is the duration of the experience, which has been defined asthe amount of time that elapses between the beginning and end of anemotional episode. The beginning and end of an emotional episode can beidentified relatively easily, since unlike the state of mind that isless specific, less intense, more durable and less given to be activatedby a given stimulus, emotions begin with an external and internal event.It has been observed that the duration of emotions is highly variable,where there are some that last a couple of seconds and others that lastfor hours or more. While sadness tends to last a long time, shame,disgust and fear tend to last a short time

Verduyn et al (2012), affirm that a characteristic of emotions is theirintensity and that during an emotional episode the intensity varies,giving rise to a profile of intensity over time which can have differentforms and where the variability of the intensity profile of the emotioncan be described by three functional characteristics; the inclination atthe beginning of the emotion (slope), the asymmetries in the profile andthe number of maxima. However, it is not clear what are the factors thatdetermine the variability of each of these characteristics.

Music and Frissons

Frissons known as aesthetic musical chills are a psychophysiologicalresponse to a gratifying auditory and/or visual stimulus that induces apleasant affective state or otherwise said of a positive valence. Thefrisson are characterized by the chills that cause, in some cases bypiloerection and pupil dilation and are studied by psychology andneuroscience. However unlike the chills in the frissons there aretrembles and great emotional intensity. The frisson implies a pleasantbut variable sensation, since it affects different parts of the body,depending on the person and the circumstances of the induction and thatcomprises sensorial, affective biological, and psychological componentssimilar to those of a sexual orgasm.

Grewe O. et al (2010) presented evidence that frissons can be provokedby auditory, visual, tactile or gustatory stimulation and could even beprovoked by mental self-stimulation (without external stimuli). They didan experiment in which in which the participants were presented with 73stimuli (23 images, 23 sounds, 23 music, 2 tactile and 2 gustatory) andthen they were asked if said stimuli induced frissons. For the tactilestimuli a device was used for massages in the head and a feather in theneck and for the gustative 2 acid juices were used.

Goldstein A. (1980) argues that the most frequent place of origin of thefrissons is the upper area of the spine (67%), the back of the neck(62%), the shoulders and lower part of the spine dorsal and the scalpthat were mentioned by 25% of the participants. In general, thepropagation of tremors occurs with an upward radiation patterns; to thescalp (65%) and face (39%), out to the shoulders (61%) and to the arms(63%) and down to the spine (52%), to the chest (34%), to the genitalregion (29%), to the thighs (30%) and to the legs (28%).

Godstein's study showed that the greatest ability to provoke frissonscorresponded to musical passages (96%), movie scenes (92%), naturalbeauties or art (87%), physical contact with others people (78%) andnostalgic moments. With less frequency to provoke frissons were somemoments of a sporting event (52%), some fragrances (39%), physicalexercises (36%) and military parades (26%). He also showed that thefrissons were invariably associated with sighs, palpitations, tension inthe jaws and facial muscles and a lump in the throat and even a softorgasm. As a summary, 91% of one of the two groups of participants and76% of those in the second group found them pleasant.

Craig D. (2005), made an experiment consisting of making objective andsubjective measurements to evaluate the physiological and psychologicalchanges that occur during the frissones induced by music. The resultsconfirmed that the frissons are associated with physiological anddiscrete events that can be measured objectively, both in musicians asin normal listeners and in front of known or unknown pieces of music.The results indicate that the frissons are associated to changes in theGSR and sometimes to a piloerection. The study concludes that frissonsare more related to a general activation of the sympathetic branch ofSNA than to thermal changes in skin temperature. According to SalimpoorV. et al (2009), the frissons are not experienced by anyone, but sincethe physiological parameters to evaluate them are so objective, theeffectiveness of their occurrence is simple to determine, although notthe degree of pleasure they provoke.

According to Harrison L. and Loui P. (2014), extreme emotionalexperiences (spikes), which include those that provoke musical frissons,occur in two distinct areas of the dopaminergic reward system(neurotransmitter present in areas of the brain that regulate pleasureand motivation). In the caudate nucleus that is activated anticipatingthe maximum of the emotion and in the nucleus accumbens that isactivated immediately after the maximum. Additionally, the structuraland functional connectivity between the auditory, emotional areas andthe reward processing system is a successful predictor of the frissons.

Blood A. and Latorre R. (2001) found that music-induced frissons wereassociated with changes in blood flow in the midbrain, in the striatum,in the bilateral amygdala, in the left hippocampus, and in the cortexventromedial prefrontal. This pattern may reflect a “craving” effect,similar to that associated with sex, drugs and food. It is possible thatthe reason why the human being develops such an affinity for thefrissons induced by music is that when we experience them we develop adopaminergic anticipation by repeating the experience, with those whoare slightly addicted to the musical stimuli that induce them.

According to the authors Salimpoor V. and Zatorre R. (2013), thedopaminergic system initially evolved to give the organism a sense ofpleasure in order to reinforce adaptive behaviors. Later men learned touse other more powerful and efficient means of activation. Manysynthetic drugs point to this system to release dopamine and thusproduce states of euphoria; It is possible that an aesthetic stimulussuch as music produces a similar effect.

Colver M. and El-Alayi A. (2015), highlight the emotional nature of theFrissons and argue that a greater openness to experiences, one of thefive features of the personality model of the “Big Five” (together withresponsibility, extroversion, kindness and neuroticism), would cause agreater number of frisonns. To demonstrate this, they evaluated thefeatures of a group of participants who were later made to listen tomusic known to induce frissons. The occurrence of these was verified bymeans of self-reports and the galvanic response of the skin and, asexpected, the frequency of frissons was positively correlated with thedegree of openness to the participants' experiences.

The results of this experiment by Colver and El-Alayi indicate that notonly the emotions explain the frissons, but also that there arecognitive factors involved, this agrees with the findings of Grewe et al(2007), as to what was more likely that people who concentrate more on aparticular music could experience more frissons. In addition, theseresearchers concluded that frissons have an important cognitivecomponent associated with anticipation, prediction and working memory,all of which are related to the personality trait of openness toexperiences.

Arrom M. (2015), conducted an experiment whose objective was to know howpersonality and coping strategies (adaptive and maladaptive) affect theperception of pain and the daily life of patients with chronic pain.

By coping strategies is called the set of cognitive and behavioralstrategies that the person uses to manage internal or external demandsthat are perceived as excessive for the individual. The conclusions ofthe study were the following:

-   -   The coping strategies that least interfere in daily life are the        adaptive ones; such as self-instructions, ignore pain and        distracting responses.    -   The most adaptive personality trait is openness to experiences.

Visual Stimuli

More than 80% of human sensory impressions are perceived through oureyes and ears and therefore audiovisual stimuli, caused by rhythmiclights and sound stimuli, are a way of externally influencing the brainand an effective method to diminish the stress, anxiety and theperception of pain. It has been shown that the distraction caused byaudiovisual stimuli diminishes pain as a result of distracting theattention from it.

The authors Bloomer C. et al (2014) point out that stressful events,where there are visual and/or auditory stimuli, provoke the “fight orflight” response that promotes the activation of the sympathetic nervoussystem and causes measurable physiological changes in the body. Theseauthors made a study comparing the sympathetic response to stress causedby auditory stimulation (hearing aids and blindfolding) versus visualstimulation (videos). The authors defined as a response to stress asignificant increase in heart and respiratory rates and the galvanicresponse of the skin.

As a result the heart rate decreased more for the visual stimuli thanfor the auditory ones, the conductance increased more for the visualones and the respiratory frequency increased more with the auditorystimuli. The researchers concluded that there are no significantdifferences between auditory and visual stressors, although this couldbe explained by the characteristics of the video contort.

M M Tse et al (2002), argued that for hospitalized patients, andsubjected to medical procedures, the environment causes anxiety, fearand depression, which aggravated the pain. The researchers evaluated theeffect of visual therapeutic stimulation, through videos, on thethreshold of pain and its level of tolerance to it.

To verify this hypothesis, the authors did a controlled trial in whichthe participants were divided into 2 groups, one of them was a videopresented with landscapes, but in silence and the second one with ablank screen. The pain was caused by the modified tourniquet technique,the pain threshold was defined at the time the patient reported thestart of the pain and the level of tolerance was defined as the momentthe person reported unbearable pain. With the results obtained in theexperiment, the authors concluded that visual stimuli considerablyincreased pain threshold and pain tolerance.

On the other hand, the authors Triberti S. et al (2014), highlight thatpain is reduced by environmental stimuli that divert attention fromharmful events so that immersion in a virtual reality environment,generated by computer technology, is a efficient tool of distraction inpain management.

In U.S. Pat. No. 6,425,764 B1, the inventors point out that duringexposure to virtual reality therapy, patients receive visual, auditoryand tactile sensory stimuli, with which they can interact. Virtualtherapy is a non-invasive, three-dimensional, interactive, self-help andlow-cost immersion experience. In this context, they developed amethodology to treat different psychological, psychiatric or medicalconditions using a psychological strategy associated with a virtualreality environment.

The authors Shaygan et al (2017), point out that one of the mainadvances in the understanding of pain is that nociception is notidentical to the perception of pain, since the former is influenced byvarious psychological factors. As an example, it has been shown that thelevel of attention and/or the emotional state regulate the response topain. The emotional state is evaluated in two dimensions, valence andexcitement, where the valence is defined as positive (pleasant) ornegative (unpleasant), while the excitement (high or low) reflects howcalm the person is.

These authors then carried out an experiment to investigate theattenuating effect of different images in patients with chronic pain,since they were interested in observing whether the attenuating effectof the pain was regulated by the valence of the photos and theexcitation. Patients were presented with photographs of their lovedones, landscapes and others and were asked to rate the intensity of thepain and their sensory and affective experience, before and after seeingthe images. As expected, the results showed that the photos of the lovedones had a high positive valence and reduced the pain more than othertypes of images.

Vibrotactil Massages

The American Massage Therapy Association (AMTA) describes massage as “asoft manipulation of soft tissues including taking them, causingmovements and/or applying pressure”, another definition of massage isthat it is “a systematic tactile form and a kinesthetic stimulation”.According to the author Field T. (2017), moderate massage is one of themost effective known of alternative therapies.

The mechanism most commonly used to explain the therapeutic effects ofmassage to reduce pain is the aforementioned Theory of the Gate, whichconsiders that pain stimulates the nerve fibers shorter, less myelinated(Aδ) and slower to bring the stimuli to the brain, in comparison withthe pressure signals that are conveyed by myelinated fibers, long (Aαand Aβ) and fast, which block the arrival of the former.

On the other hand the authors Rios E. et al (2017) point out thatself-massage is an active technique where participants use severalinstruments (massage balls and others), to apply pressure on softtissues in an attempt to imitate the techniques manuals The literaturediscloses various techniques in which positive responses to certainstimuli are associated, a phenomenon controlled by the Central NervousSystem.

There are different mechanisms that have been studied to determine theeffects of massage therapies in the relief of chronic pain. As anexample, researchers Chang Y. C. et al (2015) conducted an experimentwith patients with chronic myofascial pain who underwent two treatments;one received physical therapy and self-massage and the second onlyself-massage. The latter group showed a significant decrease in pain andan increase in the threshold of chronic pain.

In U.S. Pat. No. 7,927,294 B2 a manual device capable of massaging andwashing the hair or massaging it, delicately and effectively, by meansof a brush or part of it, is disclosed. A large number of projectionsare arranged on the surface of a flexible plate of the body of thedevice, where the brush is located, so that the projections aresymmetrical with respect to an axis A and perpendicular with respect toan axis D of in the surface of the body plate.

According to the authors Goldstein S. and Casanelia L (2010), thevibratory massages are groups of techniques that consist of rhythmicmanipulations of the soft tissues. These rhythmic manipulations have aunique oscillation pattern that depends on the type of vibration appliedand of the “seal” of the vibration (light and/or caressing, slow and/orheavy or rough). Vibrations that differ in frequency, amplitude,pressure and area of exposure cause resonances or repercussions,undulations and rebounds within the body.

In the utility model CN 205181749U a multifunctional vibrantphysiotherapy equipment is described, which includes the body of thephysiotherapy equipment, wherein the body of the physiotherapy equipmentpasses through a hinge connection, and which is equipped with a slot formassaging the feet.

Vibration is a mechanical stimulus characterized by an oscillatory wave.The biomechanical factors that determine its efficiency are frequency,amplitude, acceleration and duration. Three ways of administering thistype of therapies are recognized:

-   -   The vibration enters the human body by the hand by grasping a        vibrating element.    -   The vibration is applied directly to the muscle through a        vibrating element.    -   The vibration enters the body through the feet on a vibrating        platform.

Uher I. et al (2018), conclude that depending on their characteristicsthe vibration can affect the human body in different ways, such aschanges in the elasticity of blood vessels, improvements in peripheralcirculation, stimulation of lymphatic circulation, relief of pain,increase in the elasticity of tendons and fascia, increase in musclestrength and flexibility, improvements in the functioning of themetabolism and in mental health and relaxation in the whole organism.

Poenaru et al (2016) point out that the vibration stimulates specificreceptors, cutaneous and musculo-tendinous. Afferent impulses travelthrough the spinal cord to the thalamus and to cortical regions. Thelocal response to vibration is a tonic vibrational reflex, which dependson the frequency, amplitude and length of the tendons and muscles. Inrelation to the equipment to apply the vibration there are small unitsthat are applied directly in a muscle or a tendon, to larger equipmentwhere the patient receives them standing up; platforms. Currently thereare two types of platforms in the market; those that produce alternatelateral vertical sinusoidal vibrations (SV) and those that producevertical synchronous vibrations (VV).

In the patent DE 102010047757B3 a dumbbell is described with a tubularbar, inside which there is a vibrating device, which is characterized byhaving two electric motors, one at each end of the dumbbell, which areconnected to each other by means of an axis that rotates.

In U.S. Pat. No. 5,327,886 is disclosed a device for electronic massagethat has the function of a pad and includes an eccentric wheel driven bya motor that turns and produces vibration and a thermoelectric modulethat produces cold or heat for the pad, as appropriate. The device alsohas a fan to dissipate excessive heat and can be used only as a coldcompress or as a compress and massager.

Boehme R. et al (2018) did a study to differentiate tactile stimuli(including massages and caresses), made by oneself from those of thirdparties, since the mechanism that causes this distinction is currentlyunknown. Through the results obtained in functional magnetic resonanceImaging (fMRI), these researchers concluded that touching oneself causesa broad deactivation in the brain, which clearly differentiates it fromaffective contact made by third parties. This difference was significantand was manifested early in the sensory processes by the amplitude ofthe spots in the right anterior cerebral cortex (less clear whentouching Itself). At the behavioral level, sensory attenuation producesa higher perceptual threshold in these circumstances, that is, thestimuli themselves are perceived less.

The fact of having a lower perception to the tactile stimuli provoked byoneself when compared with those of third parties, could have certainsimilarity with the fact that we can not tickle ourselves. Althoughaccording to the authors Blakemore S. et al (2000), the attenuationmechanism in ticklings is due to sensory predictions made by a model ofinternal anticipation in the motor system. The anticipation model canpredict the sensory consequences of the movement, anticipating thecommand to be executed, which means that when the movement occurs bywill, its sensory consequences have already been predicted in advance.

According to Harvey L. (1992), all models of stimulus detection anddiscrimination have at least two psychological components or processes;the sensory process (which transforms physical stimulation into internalsensations) and the decision process (which decides the response toadopt). All this can be summarized in the following sequence, where thedetection is based on the two internal processes (sensory and decision):

In a study conducted by Sutton S. et al (1965): it was observed that theevoked potential by light and sound stimuli in conditions of uncertaintyshowed differences, when compared with the sensory modality, dependingon the level of subjectivity of the individual in the presentation ofthe stimulus (perceptions, arguments and language based on the point ofview of the subject). There were also differences in the evokedpotential according to whether the modality in the presentation of thestimulus was correctly anticipated by the individual.

Cold Therapy

According to the author Rastogi A. (2018), cold therapy or cryotherapyis the treatment for pain that uses the method of locally cooling theirritated nerve and is used for rehabilitation with a mild cold(inflammation, edema and others) or to destroy with intense cold tissuesmalignant or not. Cryotherapy includes many specific techniques; icebags, frozen gels, Ice massages, immersion in ice coolants (eg N2) andothers.

Ernst E. and Fialka V. (1994), maintain that the body or its parts canbe easily cooled by ice or other means and that this causes a decreasein the temperature of the skin, of the subcutaneous tissues and to alesser extent of the deeper muscle tissues, bones and joints. Thekinetics of the change in temperature depends, among other factors, onthe absolute temperature of the cooling agent, on the duration of theapplication time, on the vascularization of the tissue and on the localflow of blood. Generally the cooling effect is of short duration oncethe cooling agent has been removed, but in the deeper tissues the coldmay take longer to dissipate.

Chesterton L. et al (2002), affirm that several studies have beenconducted to establish the critical level of cooing of different typesof tissues to obtain specific effects. As an example to achieve alocalized analgesia in the skin a temperature below 13.6° C. isrequired, to reduce the conduction velocity of the nerves by 10%, atemperature lower than 12.5° C. is required and to reduce the enzymaticactivity by 50%, temperatures below 10 or 11° C. are suggested.

The authors Smith K. and Zhu L. (2010) developed a model of the humantorso to simulate the behavior of the spinal cord before it cold, wherethe torso is modeled as a rectangular column and the spinal column andspinal cord as tubes concentric separated by the cerebrospinal fluid.The spine, composed of cartilage and bones, is simplified as ahomogeneous cylinder, the spinal cord as a whole in which the graymatter is not distinguished from the white and the rest of the torso ismodeled as muscle tissue. The model assumes all the thermal propertiesas homogeneous and isotropic and the Pennes heat transfer bio equationis used.

Eckart S. (1974) argues that tremors called chills are a suitablesomatomotor response for thermal stress caused by cold. He also statesthat several researchers observed tremors induced by the cold during thecooling of the spinal cord, which were verified by visual and palpatorycontrols and agreed that they are real chills caused by a cold stimulusin the spinal cord.

On the other hand there are experiments with anesthetized dogs showingthat chills induced by a) external cooling, b) hypothermia and c) by aselective cooling of the spinal cord, caused tremors of equal frequencyin animals. Then it was observed that those irruption called chills, or“frisson reflexes”, could be observed at the beginning of the tremors inthe 3 types of cold stimulation mentioned above.

U.S. Pat. No. 6,023,932 A1 shows a portable device for the localtransfer of cold in humans and animals when they require it to relievepain or inflammation of both muscles and joints. The device comprises athermoelectric unit having a cold side and a hot side, a DC power sourceconnected to the thermoelectric unit, a heat sink that is associatedwith the hot side of the thermoelectric unit, a fan to reduce the heatof the heatsink and a band or the like to fix the device to the person.

In the US patent 2007/0225781 A1, an apparatus and method is describedand/or cooling or heating certain areas within the body. With respect tothe cold the system can cool the nerves of the body up to about 15° C.,which decreases nerve impulses. The system has cold elements that can bePeltier cells or a catheter through which cold or hot water is passedthrough. The hot portion of the Peltier cells can be cooled by a coolantthat absorbs the heat and then dissipates it.

Aromaterapy

According to Edris A. (2007), essential oils are natural compounds,complex and with different components, mainly terpenes, and there aredifferent ways to extract them from different plants, including water orsteam distillation, extraction with solvents, with pressure or withfluids. supercritical Essential oils have been attributed differentbeneficial properties, which according to the author has beenscientifically proven. More than 40 plant derivatives have beenIdentified for medicinal or therapeutic use, where lavender, eucalyptusand chamomile are the most used.

Louis M. and Kovalsky S. (2002) conducted a study to measure theresponse of 17 hospitalized cancer patients to a lavender oilaromatherapy humidifier. The vital signs were measured as well asanxiety, depression and the feeling of well-being. The results showed apositive but small effect on blood pressure, pain, anxiety, depressionand level of well-being.

Lakhan S. et al (2016) point out that there are many studies in whichthe benefits of aromatherapy are exposed, however research has focusedon the management of depression, anxiety, muscle tension, sleep, nauseaand the pain. For this reason they did a literature review and ameta-analysis to demonstrate the effectiveness of aromatherapy in thetreatment of pain, selecting 12 of those studies. The results indicatedthat there Is a positive effect of aromatherapy, compared to a placeboor conventional treatments to reduce pain. A second analysis found thataromatherapy is more consistent to treat nociceptive and acute pain thaninflammatory and chronic pain, respectively. These researchers concludethat aromatherapy is safe, that no negative effects are reported, thatthe costs of treatments are low and that more research is required tofully understand the clinical applications.

On the other hand, Schneider R. et al (2018), like Lakhan et al (2016),affirm that there are few studies regarding the efficiency ofaromatherapy and that some have weaknesses in research methodologies. Intheir work they analyze the conditions under which aromatherapy is moreefficient, for which they studied the characteristics of the olfactorysystem and the characteristics that odorants must have to havetherapeutic effects. Then they tested the effect of an inhaler(AromaStick), which acts on various physiological systems, such ascardiovascular, endocrine pain and others, both in the long and shortterm. The authors conclude that the inhalation of essential oils had animmediate, important and clinically relevant result as long as they weredelivered in a high concentration and by an appropriate device.

International patent application WO 2006/084921 A1 discloses a diffuserfor volatile substances of the type that are connected to the electricalnetwork, for sequentially or simultaneously diffusing several fragrancesby manual activation or according to a predetermined program. In theU.S. Pat. No. 9,849,206 B1 a diffuser of liquid perfumes is described,which allows the release of these to the environment only when desired,in order to prolong its use with the consequent saving of perfume.

Perceptual Learning

Gold J. and Watanabe T. (2010), point out that perceptual learning isthe increase, fruit of experience, of our ability to understand what wesee, what we hear, what we feel like or smell. These changes arepermanent or semi-permanent, so they differ from short-term mechanismssuch as sensory adaptations or habituation. Permanent or semi-permanentchanges have been taken as evidence of the plasticity of brain regionsinvolved in sensory tasks.

Changes in sensory tasks are not merely incidental but rather adaptiveand therefore provide various benefits such as greater sensitivity topick up weak or ambiguous stimuli or require a lower level of stimulusor a shorter period of time to perceive them. In summary, perceptuallearning has three characteristics; it is a lasting learning, it isperceptual (the way the brain senses sensations) and it is a product ofpractice (experience).

The ways in which perception adapts to tasks and the environment are thefollowing: differentiation, unification, attentional weighting andimpression of stimulus.

-   -   a) Differentiation: One of the most used mechanisms for        perception to adapt to the environment is when the percept        (object of perception) differs from the rest. The stimuli that        were indistinguishable now separate.    -   b) Unification: It is the mechanism of perceptual learning that        goes in the opposite direction of differentiation. Unification        involves the construction of singular units in response to        complex configurations. By unification a task that could require        the detection of several parts now only needs one.    -   c) Attention weighting: When by practice or experience people        increase their attention to the perceptual dimensions and        characteristics that are important and reduce attention to the        dimensions and characteristics of minor importance.    -   d) Impression of the stimulus: A second way in which perception        can adapt to the environment is by marking them. By marking        them, the detectors (receivers) specialize in stimuli or parts        of stimuli.

Synchronization of the Senses

According to Recanzone G. (2009) objects and events in real lie comprisemultiple sensory attributes, which are processed in differentindependent modes. However, the way to combine this sensory informationto give shape to a unique perceptible object is not yet clear. Combininginformation about a common source with different characteristics,through the senses can improve discrimination and reaction to variousobjects.

King A. (2005) argues that there are numerous neuronal and non-neuronalfactors that Influence how long the signals, which arise from the samesource, reach the multisensory neurons in the brain. As an example,sound travels much slower than light and therefore arrives later,however the process of auditory transduction is much faster than theprocess of transduction in the retina, which makes a difference in theresponse of both neurons, auditory and visual, from 40 to 50milliseconds in favor of the latter.

This author affirms that synchronization over time is a particularlypowerful tool to unite stimuli and it has been demonstrated that humansare capable of performing an accurate assessment of the simultaneousoccurrence of auditory and visual cues, despite variations in relativetimes in that are slow to arrive. A second powerful tool to unifystimuli is the spatial one, since there are multiple cases in which asensory modality dominates the percept of an object or multisensoryevent. A classic example is the ventriloquistic effect, where thepercept of an auditory stimulus is “captured” by the spatial location ofa visual stimulus.

According to Noy D. et al (2017), even though the signals of thedifferent sensory systems are processed with noise and asynchronously,the function of the Central Nervous System is to make the best estimatefrom inaccurate information; what it would do through a mechanism thatoperates as a Maximum Likelihood Estimator. The efficiency of thisoperative function can be seen when two people walk together, for whichboth individuals must synchronize the signals of movement, of touch,visual and auditory with those of their own signals.

GENERAL DESCRIPTION OF THE INVENTION

Chronic pain has a physical, emotional and cognitive dimension in theindividual and the frissons are positively related to all of them withthe aim of alleviating the chronic pain of patients. The purpose of thisinvention is to induce frissons through multisensory and multimodalstimulation, wherein the stimuli that elicit them are related to thesenses of hearing, vision, touch, and smell. To achieve this objective,it is important that the various stimuli act synchronously around themusic, since the latter has proven to be the most efficient way toelicit them. A secondary objective of the present invention is tointensify and keep the previously induced frissons in time in order tomaximize the pain relief in the patient.

It should be noted that taste was not considered within the methodologyused, since taste and smell have the same type of receptors and both arestimulated by the molecules that float in the air. Odorants come frommolecules in the air that stimulate the receptors in the olfactory bulb;if there is no receiver for that specific odorant, the odorant has nosmell. If one of the those senses does not work well, the other will notwork either because of the relationship between the receptors. There isalso a practical reason derived from the lack of literature, with theexception of the work of Grewe O. et al (2010), in relation to theeffect that gustatory stimuli have on inducing frissons.

In general terms, the equipment for the treatment of chronic pain ofthis invention, which can be operated by the patient himself orinitially with the help of an assistant, comprises a computer with amusic and a video player and a computer system that mainly controls thehydraulic circuit with a cooler and an actuator, illumination and adiffuser, and to enhance their effects, recourse to perceptual learning.Below are the mechanisms, considerations and limitations to elicit suchstimuli and the expected responses, frissons and others, for each one ofthem.

Musical and Visual Stimuli

It has been demonstrated that music and visual stimuli can produceintense emotions and frissons, as well as improvements in physicalcondition, a decrease in stress and anxiety, depression reduction,improvements in mood and cognitive functions, and a decrease in chronicpain. Notwithstanding the above, not all musical and visual stimuli areappropriate to elicit frissons and decreases in pain. Next, differentaspects of the patient, the stimuli and the way to present them areanalyzed.

Musical Stimuli

Regarding music, we must bear in mind the characteristics of the patient(sex, age, behavior, emotions, feelings and mood), about of his illness,physical state and others), of the physiological parameters (bloodpressure, heart and respiratory rate), conductance of the skin andothers), of the emotions that the music induces (joy, anxiety, sadnessand others), about the characteristics of the music (musical genre,volume, rhythm, harmony, metric, compass, melody and the notes), thesurrounding environment (luminosity, noise, temperature, colors andothers), the frequency of stimuli presentation and duration of sessions,preferences for self-selection or delivery, sequence and randomness.

Physiological and Psychological Effects of Music

Emotions, whose understanding and effects are fundamental in thisinvention are defined as a complex state of feelings that result inphysical and physiological changes that influence on thoughts andbehavior: emotionality is associated with different psychologicalconstructs including temperament, personality, mood and motivation.There is a debate about the emotions that music elicit in individuals,Arjmand H. et al (2017) and others sustain that they respond tosignificant environmental events potentially important for the survivalof the individual (utilitarian model, reaction fight-flight). However,other studies show that music elicit emotional aesthetic reactions thatgo beyond the merely utilitarian.

The generation of an emotion in the subcortical regions of the brainactivates the hypothalamus, the Autonomic Nervous System (ANS) and therelease of adrenaline and cortisol. The activation of the ANS includesthe sympathetic nervous system, which prepares the warming and strengthreactions (fight-flight) and the parasympathetic one that acts duringthe digestion and the rest, both systems predominate according to thecontext. The sympathetic causes, through hormones, the alteration ofdifferent tissues and organs, including cardiac and respiratoryactivity, as well as blood pressure. According to Koelsch S. and JanckeL. (2015), the heart rate (HR) and respiratory rate (RF) increase inresponse to the exciting music (stress) and decrease with the relaxingmusic. During the musical frissons (involving shuddering andpiloerection) the FC and the FR increase. In addition both of them tendto increase with the music, when compared with silence and FC decreaseswith the unpleasant music and increases with the pleasant one.

Plutchik R. (1980) developed an evolutionary theory about emotions andproposed that humans have evolved to adapt our organism to theenvironment and divided emotions into 8 categories, with emphasis onthose related to survival: fear, surprise, anger and 8 more of anadvanced level. The rest of emotions would be combinations of theprevious ones to broaden the range of experiences. According to thistheory, emotions vary in their degree of intensity and the more intensethe emotion more will motivate the related behavior.

On the other hand, feelings are moods that are produced by causes thatimpress you, and these can be cheerful and happy or painful and sad. Thefeeling arises as a result of an emotion that allows the subject to beaware of his mood. Unlike emotions, states of mood (AE) do not have aclear event that causes them, or if it had occurred, it is not clearlyIdentifiable by those who experience it. AE are diffused and longerlasting affective states that do not have an specific orientationtowards a certain stimulus”; Fridja N. (1999).

According to Turk D. and Wilson H. (2010), the evidence from severalstudies supports the role of biological, psychological and environmentalfactors in the etiology, exacerbation and maintenance of chronic pain.It is common for this type of patients to experience anxiety and fearand a low state of mind, which worsens their situation.

Anxiety: There are studies that show that anxiety levels can predict theseverity and behavior of patients with chronic and acute pain. As wellas that the techniques of reducing anxiety and the use of anxiolyticdrugs reduce the pain derived from medical procedures.

Fear: There is scientific evidence that negative individual evaluationsof pain, including pessimistic interpretations of it, such as that thebelief that pain is associated with various pathologies, and thattherefore harms, contribute to the development of pain-fear association.The extremely negative interpretation of pain induces fear responses;physiological (activation), cognitive and behavioral (avoidance).

Cognition: Cognitive changes that occur during fear increase theperception of the threat, increase attention, which then increases thecatastrophic assessment of pain, avoidance and the level of disability.

Depression: It has been observed the existence of a considerable overlapbetween pain and depression which induces changes in the patient'sneuroplasticity and brain neurobiological mechanisms. Such changes arefundamental to facilitate the occurrence and development of chronic painand chronic pain induced by depression.

Below are described some characteristics of the person and about musicalkeys that can make the perception of music, emotions and moods differbetween people.

Gender Identity: It has been suggested that if the information conveyedby a music has gender identity, related to a specific sex, theperception of the listeners would be slightly different. However thereare opinions that music would not be related to gender characteristics,but would be attributed by listeners. Sergeant D. (2016).

Personality and mood: It was observed in a group of individuals whoevaluated 50 musical pieces, in terms of the emotion they perceived(fear, happiness and others) that the evaluation done was a function oftheir moods. It was also observed that the personality of theindividuals, measured prior to the evaluation, was linked to theirevaluations Vuoskoski J. and Eerola T. (2011).

Rhythm and Tempo: The rhythm is the harmonious combination of sounds,voices or words, which include pauses, silences and cuts and the tempocorresponds to the speed with which a piece of music is played. Thetempo determines the music causes happiness or sadness; a high tempowould be fun or expressive and a low one relaxing or boring. It has beenobserved that the tempo is the musical characteristic most related tothe affective states. As for the effect of the rhythm, it would go inthe same sense as the tempo. Fernandez-Sotos et al (2016).

Musical genre: The musical genre is a category that brings togethermusical compositions that share different criteria of affinity, such asits function, its instrumentation, its rhythm, its culturalcharacteristics and others. It has been observed that emotions,especially those related to valence, would be different depending on themusical genre. As an example, the opera involves music and singing aswell as a large audiovisual framework from the orchestra and set design.Rodica F. et al (2011).

Visual Stimuli

Ulrich R. S. et al (1991), argues that the parasympathetic is involvedin the recovery of normal levels of heart rate post-stress, sinceparticipants undergoing a stressful event recovered quickly aftershowing them a video with natural environments, this is consistent witha response of the vagus nerve, which is related to the parasympatheticand that (among its functions controls the heart rate). Gladwell V. etal (2012) showed that the parasympathetic activity of a participantgroup, after a stress, was greater when they observed a forest than agroup of buildings and it was even greater when the forest was presentedbefore the event stressful

Kort Y. et al (2006), performed an experiment in which the participants,after having done a stressful task, watched a film of nature, either ona small or a large screen, while evaluating their physiologicalparameters. The results indicated that the larger size of the screen andtherefore the higher the degree of immersion in the film facilitatedpost-stress recovery in terms of physiological measurements.

Lee J. et al (2011), developed a study that supports the evidence thatentering a forest serves as a natural therapy and investigates thephysiological benefits of this practice. The results indicated that theenvironment of the forest significantly increased parasympatheticactivity and reduces sympathetic activity among the participants(reduction of salivary cortisol), which contrasted with the resultsobserved in an environment with buildings. Also in the psychometrictests, the fact of entering a forest improved the positive feelings anddiminished the negative, when comparing the effect that there was inurban environments.

Baños R. et al (2012), did a work in which they tested two virtualenvironments in the elderly to see if they improved the mood, enjoymentand relaxation between them. The virtual environments containedexercises to generate autobiographies, mindfulness and quieting thebreath. The results indicated that the presentation of both virtualenvironments increased enjoyment and relaxation while reducing theheaviness and anxiety.

For Grinde B. and Grindal G. (2009), contact with nature has beneficialpsychological benefits by reducing stress, improving attention, having apositive effect on mental recovery and addressing attentional deficits.Additionally, there would be direct health benefits such as increasinglongevity and Improving overall health. These benefits are associatedwith different natural experiences, such as natural deserts, parks andneighboring outdoor gardens. Additionally, several studies show thebenefits of having plants indoors; in patients who have been shownphotographs of hospital rooms, with and without indoor plants, theformer reduce the stress reported in self-reports.

Diette G. et al (2003), did a study, presenting visual and auditorystimuli, to determine which visual distractors and sounds would reducepain and anxiety in post-surgery patients, for which they presentedmurals with natural views, during and after of the procedure. They alsoreceived audio, before, during and after the surgery, at the same timeas the intensity of the pain and the level of anxiety were evaluated.The results indicate an efficient response of distraction therapy withnatural views and sounds to decrease pain.

Tactile Stimuli

In the present invention the tactile stimuli are presented by means of aclosed hydraulic circuit with 3 pumps, one of them peristaltic 2diaphragm, in addition to flexible tubes to drive the fluid,connections, an actuator, a cooler with Peltier plates, a sensor oftemperature and a thermostat. This equipment allows to massage withlight strokes and caresses, apply cold and vibrations, joint orcombined, on the skin surface and the muscles of the upper part of thespine, of the patients.

The skin is innervated by skin receptors that belong to thesomatosensory system, which make up the sense of touch and capturedifferent specific stimuli that provide information to the CentralNervous System (CNS): mechanoreceptors, thermoreceptors (temperature)and nociceptors (pain). Where the mechanoreceptors provide informationabout touch, pressure, vibration and skin tension and according to theirfunction are classified in the corpuscles of Meissner, Pacinianos andRuffini and Merkel discs. Within the tactile recetors are tactile CTnerve fibers that have a low threshold, are not myelinated and have alow speed of signal conduction.

Ettzi R. et al (2018), affirm that caresses represent one of the mostcommon ways to receive and transmit affections through touch and theevidence suggests that the pleasant perception of soft caresses ismediated by the tactile or tactile nerve fibers. CTs. To demonstratethis, the authors set up an experiment to observe how the physiologicalexcitation varied according to the type of tactile stimulation appliedto the forearm. During 9 to 60 seconds they applied slow (3 cms/s) orfast (30 cms/s) strokes and fixed or random tapping. The resultsindicated that slow caresses induced greater galvanic responses of theskin, in the subjective evaluations of the participants, than thepatting.

According to Malamud-Kessler C. et al (2014), vibro-tactile perceptiondepends mainly on the mechanoreceptors of rapid adaptation (Pacini andMeissnner corpuscles) and slow (Merkel discs). From the mechanical pointof view, the sinusoidal wave has different characteristics (amplitudeand firing frequency) that generate different vibrotactile perceptions.In addition, the vibration threshold is defined as the lowestoscillatory displacement capable of being detected and there aresignificant differences in the thresholds depending on the frequency,the magnitude, the contact area and the location of the vibrotactilestimulation.

The vibratory sensitivity in the corporal periphery has differentcharacteristics depending on the body region that receives the stimulus,among them the existence of glabrous skin areas and the differentreceptors and afferent fibers that innervate them. The average densityof the hair follicles in the forehead is significantly higher than inother areas of the body (292 hair follicles/cm2) compared to the back(29 follicles/cm2). Seah S. and Griffin M. (2006), compare thevibrotactile thresholds of men and women and of young people with adults(in glabrous and hairy skins) where it was possible to determine thatthe vibrotactile threshold for mature men and women in the mean finger,in thresholds of 31.5 Hz and 125 Hz, was 0.12 and 0.29 respectively forwomen and 0.14 and 0.23 respectively for men.

In order to provoke caresses in the present invention, vibrations,caresses and tappings are used, in addition to cold. Cutaneousthermosensation Is regulated by receptors that transduce, encode andtransmit thermal Information. Park B. and Kim S. (2013) state that thereare two types of thermosensitive fibers, some that respond to heat andothers to cold.

Cold receptors, which perceive changes in skin temperature from 1° C.,ranging from 15 to 30° C., are classified Into 2 groups, the superficialand the deep, of which 60% It's located in the periphery of the body.These receptors can transmit information through small fibers that aremielinizated at a speed that goes from 5 to 15 m/s and also through Cfibers.

According to Smith K. and Zhu L., previously cited, based on thephysical and physiological parameters of their model, they conclude thata simple pad with a temperature of 20° C. for 30 minutes could lower thetemperature of the spinal cord in more than 2.7° C. In 30 minutes andthat the low temperature could be more than double if the temperaturewas reduced to 0° C.

In this invention the cold stimulus is applied by means of a low flow T° that recirculates inside a tube of cross section of the hydrauliccircuit and that Is applied on the skin and the muscles that cover theupper part of the patient's spine and in where the tube that touches theskin runs parallel to said column. The turbulence of the flow is mainlydue to the work of the peristaltic pump and the passage of the flowthrough the actuator. The cold is obtained from a Peltier plate cooler.In this respect it's necessary to model the behavior of the turbulentflow caused by the peristaltic pump and by the actuator, however it isimportant to note that there are few analytical studies that treat them(if they exist are for steel tubes and hoses), as well as the transferof heat between the fluid and the body tissues. Here are some modelsthat explain these phenomena:

a) Three-dimensional behavior of tubes with expandable walls thattransport compressible or non-compressible fluids. Gay-Balmaz F. andPutkaradze V. (2018) present a theory to explain them and that can besummarized in the following equations:

$\left\{ {\begin{matrix}{{{\partial_{t}\left( {\xi \; u} \right)} + {\partial_{s}\left( {\xi_{u}^{2} + {p\; A}} \right)}} = {p\; {\partial_{s}A}}} \\{{{a\; \overset{¨}{R}} - {\partial_{s}\frac{\partial F}{\partial R^{\prime}}} + \frac{\partial F}{\partial R}} = {2\; \pi \; {R\left( {p - p_{ext}} \right)}}}\end{matrix}.} \right.$

Along with the conservation of mass and entrophy.

∂_(t)ξ+∂_(s)(ξu)=0, ∂_(t) S+u∂ _(s) ,S=0,

b) Characteristics of turbulent flows; Turbulent flows have thefollowing properties: Irregularity, three-dimensionality, diffusivity,dissipation and a high Reynolds number.

The equations of fluid mechanics are based on the fact that the dynamicbehavior of a fluid is governed by the following conservation equations:

-   -   The conservation of the mass or continuity equation.    -   The conservation of the kinetic moment or the amount of        movement.    -   The conservation of energy.

By grouping the equations of conservation of the mass, the amount ofmovement and the conservation of energy, the Reynolds-Navier-Stokesequations can be obtained in three dimensions, according to Reynolds.(1895), which represents a system of 5 variables to be determined, butwith 7 independent unknown identities. Although this is the mostcomplete turbulence model, a general solution for this type of equationsis not available and simpler models such as k-ε (k-epsilon) or k-ω(k-omega) are used. They are deduced from the LES (Large Eddysimulation) model, but they have restrictions.

b.1 Model k-ε (k-epsilon) of Hanjalic K and Launder B. (1972), is themost used model in computational fluid dynamics. It is a model of 2transport equations to represent the turbulent properties of a flow. Thefirst variable of this model is the turbulent kinetic energy (K), thisvariable determines the turbulent intensity, while the second variablerepresents the turbulent dissipation (Epsilon). This model isappropriate for totally turbulent flows and the equations are:

Turbulent Kinetic Energy:

${{\frac{\partial}{\partial t}\left( {\rho \; k} \right)} + {\frac{\partial}{\partial x_{i}}\left( {\rho \; {ku}_{i}} \right)}} = {{\frac{\partial}{\partial x_{j}}\left\lbrack {\left( {\mu + \frac{\mu_{t}}{\sigma_{k}}} \right)\frac{\partial k}{\partial x_{j}}} \right\rbrack} + G_{k} + G_{b} - \rho_{\epsilon} - Y_{M} + S_{k}}$

Turbulent Disipation:

${{\frac{\partial}{\partial t}\left( {\rho \; \epsilon} \right)} + {\frac{\partial}{\partial x_{i}}\left( {\rho \; \epsilon \; u_{i}} \right)}} = {{\frac{\partial}{\partial x_{i}}\left\lbrack {\left( {\mu + \frac{\mu_{t}}{\sigma_{\epsilon}}} \right)\frac{\partial\epsilon}{\partial x_{i}}} \right\rbrack} + {C_{1\; \epsilon}\frac{\epsilon}{k}\left( {G_{k} + {C_{2\; \epsilon}G_{b}}} \right)} - {C_{2\; \epsilon}\rho \frac{\epsilon^{2}}{k}} + S_{\epsilon}}$

b.2 Model k-ω (k-omega) of Wilcox D. C. (2008)

The turbulent viscosity Vt, as required in the RANS equations (ReynoldsAveraged Navier-Stokes) is given by: VT=k/ω, while the evolution of kand ψ is modeled as:

$\mspace{79mu} {{{\frac{\partial\left( {\rho \; k} \right)}{\partial t} + \frac{\partial\left( {\rho \; u_{j}k} \right)}{\partial x_{j}}} = {{\rho \; P} - {B^{*}\rho \; \omega \; k} + {\frac{\partial}{\partial x_{j}}\left\lbrack {\left( {\mu + {\sigma_{k}\frac{\rho \; k}{\omega}}} \right)\frac{\partial k}{\partial z_{j}}} \right\rbrack}}},\mspace{79mu} {{{with}\mspace{14mu} P} = {\tau_{ij}\frac{\partial u_{i}}{\partial x_{j}}}},{{\frac{\partial\left( {\rho \; \omega} \right)}{\partial t} + \frac{\partial\left( {\rho \; u_{j}\omega} \right)}{\partial x_{j}}} = {{\frac{\gamma \; \omega}{k}P} - {\beta \; \rho \; \omega^{2}} + {\frac{\partial}{\partial x_{j}}\left\lbrack {\left( {\mu + {\sigma_{\omega}\frac{\rho \; k}{\omega}}} \right)\frac{\partial\omega}{\partial x_{j}}} \right\rbrack} + {\frac{\rho \; \sigma_{d}}{\omega}\frac{\partial k}{\partial x_{j}}{\frac{\partial\omega}{\partial x_{j}}.}}}}}$

The RANS equations and the nomenclature of the k-ε (k-epsilon) or thek-ω (k-omega) models are not presented, since they can be seen inseveral references.

Peristaltic Pump, Turbulent Fluid and Vibration

As mentioned earlier in this Invention, the turbulent flow that causesthe vibration and stimulation of the skin and the muscles that cover thespine is caused by the narrowing of the flow by the actuator or by theperistaltic pump.

According to Takabatake S. et al (1988). the pumping of a peristalticpump is a function of four parameters: the radius ϕ, the number of wavesa, the number of Reynolds Re and the time of flow (without dimension) y.There are different definitions for the Reynolds number, however in apapr done by Cheng X. et al (2017) they use the following equation:

${Re} = \frac{\rho \times v \times D}{M}$

Where ρ Is the density of the fluid (kg/m3), v is the average velocityof the fluid. D is the diameter of the tube (Internal diameter ifcircular, in mtrs) and μ is the dynamic viscosity of the fluid(Pa×s=N×s/m2=kg/(m/s) As an example and from this equation, calculatethe behavior of the Reynolds number, for different diameters andvelocities of the peristaltic pump, with values: p=1.08 kg/m3 and theinner diameter of the tube is 1.55×10↑−3. The viscosity of the fluid wasestimated at 1.06×10↑−3 Pa×s.

The Reynolds number for pump speeds of 100 rad/min, at a flow velocityof 1.69 m/s was 2678.22 and from that pump speed they were Increasingfrom 10 to 10 radians/min until reaching a maximum of 190 radians, witha flow velocity of 3.17 m/s and a Reynolds number of 5014.69. When thespeed of the pump exceeded 160 radians/min, the Reynolds number wasgreater than 4000, considered as turbulent (since Re<2300 is a laminarflow, with 2300<Re<4000 is a transient flow and greater than 4000turbulent). In short for the purposes of this invention, the greater thenumber of Reynolds, the greater the fluid turbulence and the greatergreater the vibration of the tubes and the tappings that stimulate thecutaneous surface covering the patient's spine.

Heat Transfer from Tissues to the Hydraulic System

An Important element to be determined in this invention is the heattransfer between the cutaneous, muscular and bony tissues, from theupper part of the spine and the cold and turbulent fluid (Reynolds N),contained in a tube parallel to the first ones and whose characteristicsare to be straight, of circular cross section, of smooth inner surfaceand that transport an Incompressible fluid.

According to Subramian R. (2014), the Ditus-Boelter correlation is themost recent way, and the most generally used for fluids with Prandtlnumber in the range of 0.7 to 100 and in tubes with L/D>60, where L isthe length and D the diameter of the tube. This correlation is simple toapply but is not accurate when the temperature differences betweenfluids (cold, heat) are very high and the Internal surfaces of the tubearen't smooth. The Nusselt No (Nu) is the ratio of heat transmission byconvection and conduction, in a delimited flow.

Correlation Constraints Nu_(Dh) = 0.023 Re_(Dh) ^(0.8) Pr^(0.4) 0.6 ≤ Pr≤ 160 where: Dh is the hydraulic diameter [m] Re is the Reynolds number[ 

] Pr is the Prandtl number [ 

] Nu is the Nusselt number [ 

] Re_(Dh) > 10000   $\frac{L}{D} > 10$

indicates data missing or illegible when filed

The Prandtl No. can be represented as the relationship between thekinematic viscosity and the thermal diffusivity of a fluid α (v/α). TheDitus-Boelter correlation should be used in flows with a Reynolds numbernot higher than 10,000 but in practice it is used with values lower thanthat.

Hydraulic Actuator Mechanism

A second source of turbulences within the hydraulic circuit of thepresent invention, are those coming from a hydraulic actuator, whichcauses vibrations in the walls of the tubes of the first, which aretransmitted to the skin and muscles that cover the upper part of thespine.

Moreover the hydraulic actuator consists of a cylinder that moveslongitudinally and in both directions, on a pair of pistons that arefixed and are hollow; water circulates inside of them, and that end inringed nozzles that point in an opposite way, towards both directions ofthe cylinder, discharging into the tubes of the circuit and where theactuator is fed alternately by water driven by each one of the two wayssolenoid valves, two steps, located on the sides of the cylinder andwhose openes is controlled by a computer system.

The flow continuity equation, which describes the behavior of apermanent, Incomprehensible and unidimensional flow like that of thewater Inside the pistons. Is the following:

-   -   as the water Is practically incompressible ρ1=ρ2 remains;

ρ₁ ×V ₁ ×A ₁=ρ₁ ×V ₂ ×A ₂

-   -   the inlet flow Is equal to the outflow (from the nozzle).

Q=V ₁ ×A ₁ =V ₂ ×A ₂

Since the flow inside the pistons is laminar, the following equation canbe used to determine its speed:

$v = {v_{(\max)}\left\lbrack {1 - \left( \frac{r}{R} \right)^{2}} \right\rbrack}$

Where R=tube radius and v (max) Is the maximum velocity at the center ofthe speed profile, which Implies that towards the exit of the nozzlesthe fluid speed Increases. Shademan Y. et al (2012) made aninvestigation to study the effect of the geometry of four nozzles withan Incompressible fluid and they observed that locating a ring in thevicinity of the outlet of a nozzle Increases the Incidence of turbulenceand flow speed.

Model for the Release and Intensity of the Smell of a Fragrance.

To model the release of fragrances from a simplified matrix, used in theformulation of different flavored products, the authors Costa P. et al(2015) used a new model that, depending on the conditions, could be usedin this invention. Henrys law, for a chemical dissolved in a liquid, isdefined as the ratio of the equilibrium relations between the gas andliquid phases, at a given temperature.

Ci(gas)=H×Ci(liquido),

where H Is the component of Henrys law for H and Ci (gas) and Ci(liquid) are the concentrations of the component of the fragrance I inthe gas and in the liquid phase in (gr/L).

The literature shows that the olfactory perception of a mixture offragrances can be calculated from a combination of variables, theconcentrations of odorants in a gas, its chemical structure, the odorthreshold and the neuronal signals in the transduction.

This model simplifies the analysis to predict a) the Intensity of thesmell and b) the character of a mixture of fragrances and theconcentration of the vapors in It, using a psychophysical model known asthe Law of Steven's Psychophysics, which relates the magnitude of thesensation and Intensity of a stimulus and the Strongest Component Model.

The intensity of the smell perceived in a mixture of fragrances wascalculated from the concentrations used in the Stevens Law. The model isderived from sensory experiments related to the relationship between themagnitude of the applied stimulus and the perceived sensations andcontemplates non-linear relationships between both and for the relatedto smell can be expressed assuming that the perceived sensation (ψ) isproportional to the magnitude of the stimulus (Ci gas) raised to anexponent ni:

$\psi_{i} = \left( \frac{C_{i}^{gas}}{{ODT}_{i}} \right)^{n_{i}}$

Where Ci gas is the concentration of the odorant in the gas phase, ODTiis the threshold for the concentration of odor in the air (units of massor moles per volume) and the parameter ni is defined as the exponent ofthe Law of Stevens for each odorant in particular

FIGURES

FIG. 1 shows a patient in a therapy session to alleviate chronic pain byinducing, intensifying and maintaining their own frissons, by presentingmultisensory and multimodal stimuli. Musical, visual, tactile andolfactory and that are elicit by actuators of a workstation with a PCand a monitor, an operating system, a multimedia program, an hydrauliccircuit and an actuator controlled by a computer program.

FIG. 2 (2 ^(a) and 2B), shows the way to place the hydraulic circuit inthe back of the patient in order to apply the tactile stimuli,vibrotactiles and cold, on the surface of the skin and muscles thatcover the upper part of the spine.

FIG. 3 shows a diffuser of essential oils, which has 2 circularcontainers, one for each oil, embedded in a textile fiber, together witha resistance, all inside a box with a straight parallelepiped shape andtwo holes in its upper face.

FIG. 4 shows the hydraulic circuit that allows to apply the tactile,vibro-tactile and cold stimuli and whose operation is controlled througha computer system through a PC and that comprises 3 hydraulic pumps,hoses and connections, 1 actuator, 1 cooler, 1 T ° sensor, 1 thermostat,one 3-way valve and 2 positions and another two 2 two-way and twopositions all normally closed.

FIG. 5 shows an actuator that allows to apply tactile stimuli, caresses,on the cutaneous surface covering the upper part of the patient's spine,which is complemented by two, 2-way valves and 2 positions; one on eachside of the actuator.

DETAIL DESCRIPTION OF THE INVENTION

The objective of this invention is to provide the equipment and themethod to use it for the self-care of patients with chronic pain throughfrisson induction by means of actuators, including a hydraulic circuitwith an actuator. Special mention within the stimuli used in thisinvention is occupied by music, since it has been shown to be the mostefficient way of presenting sensory stimuli to elicit frissons and forthis reason some of the tactile and visual stimuli have beensynchronized with the music (multimodal stimulation).

FIGS. 1A and 18 show how to use the hydraulic circuit (400), in shoulderstrap, with the head in (421) and the flexible tube (405), surroundingthe patient's back and allowing to elicit the stimuli and vibrotactilesof this invention. In the back of the patient the flexible tube FIG. 1Bis attached to the skin by means of double suction cups (101), loose tomaintain the vibration of the tube. The container on the patient's back(102) of FIG. 1B comprises part of the hydraulic circuit: the hydraulicpump, a 3-way valve, a temperature sensor and a cooler. The actuator(500) is located skimming the skin covering the upper part of the spine.

On the other hand, FIG. 2 shows the necessary hardware to elicit thenecessary audiovisual stimuli to enhance the cold and vibrotactilestimuli caused by the hydraulic circuit described above. Hardwareelements could be important to use virtual reality (VR) technology, butnot having it, does not prevent the patient from experiencing thebenefits of this invention.

Okechukwu O. et al (2011), define virtual reality technology (VR), asvery interactive and based on a multimedia computing environment inwhich users participate in a world generated by computers. Virtualtechnology (VT) is the simulation of an imaginary environment in 3dimensions that provides visual interactive experiences in real time,sounds, tactile sensations and other forms of feedback and is thetechnology necessary to implement VR. However, budgetary, technical orother constraints make it advisable to use this technology according tothe preferences of the patients. Virtual reality systems can beclassified into 3 types; a) non-immersive, b) semi-immersive and c)totally immersive.

Virtual reality seeks to simulate sophisticated three-dimensionalspaces, however for the purposes of the present invention, thenon-immersive approach offers a virtual world, through a simple windowon the desktop of the PC, on a high-resolution monitor. Thenon-immersive devices are lower cost and quickly accepted by users andcan be improved with future investments.

There are several studies in which the use of virtual realty inrehabilitation in general and in the management of pain through thedistraction techniques provided by VR has been studied. As an example,Shahrbanian S. et al (2012) made an extensive literature review andexperiments to determine the effectiveness of this type of treatment inpain management. The authors concluded that the distraction techniquesallowed by VR were a promising way to alleviate chronic pain innon-pharmacological treatments. The components to generate a virtualreality are divided into two types of components; hardware and software.

Hardware Components

-   -   Hardware comprises 5 subcomponents: work stations, accelerated        processing cards, tracking systems and peripheral input and        output devices:    -   Work stations: nowadays have a great development, especially in        terms of CPU, graphics, memory capacity and are optimized for        the visualization and manipulation of different types of        information. The greater the RAM memory, the greater the        efficiency of the computer.    -   Cards of accelerated processing: They allow to update the        presentation of the peripheral devices of exit with new        sensorial information, such as the graphics cards and of 3D        sound.    -   Monitoring systems: These systems determine the position and        orientation of the user in the virtual environment and are        divided into mechanical, electromagnetic, ultrasonic and        infrared technology.    -   Peripherals of sensory output: These devices are used to present        a virtual world to the user and basically comprises, the        monitor, glasses or virtual reality helmets and hearing aids for        3D audio.    -   Input peripherals: They are used to interact with the virtual        environment and with the objects inside it, such as the        keyboard, the mouse and others.

The monitor (211) should have a curved screen (not excluding), since itprovides a visual experience with less distortion, more natural and thatcauses less eye fatigue in long sessions, than those of flat screen andwith wide viewing angles. It should have a large screen (not excluding)and high resolution (not excluding), so that it is easier to work withgraphics, video and multimedia.

Audio system: Unless you want to have a good sound, without using VRheadsets, a good audio system (202) is required, which makes thetherapies more immersive. A surround sound, greater clarity and deeperbass are the benefits of a good speaker system. For this purpose we mustconsider the cost, the frequency response, the power, the impedance, thesensitivity, the performance, the distortion and the directionality.

Software Components

The software comprises four subcomponents: 3D modeling, 3D graphicssoftware, software to edit digital sounds and virtual simulationsoftwares:

-   -   3D modeling software, which allows you to build geometric        objects in a virtual reality world and specify the properties of        these objects.    -   2D graphic design software, to apply to the objects        characteristics that improve the virtual details.    -   Software to edit digital sounds, which allow to mix and edit the        sounds that the objects emit within the virtual reality        environment.    -   VR simulation software that bring together all the components.        -   Software de simulación de la VR que unan todos los            components.            Software Suitable for this Invention

For the requirements of this invention a system based on C++ programminglanguage was developed by adapting programs from the Arduino library,which contains pieces of code made by third parties.

To load our programs in Arduino or in another compatible card, the IDE(Integrated Development Environment) was downloaded. The IDE is theofficial Arduino application that allows you to program and download theprogram to our cards. With these programs the connections between themicrocontroller and the sensors and actuators for this invention weredone; The diffuser and the hydraulic circuit work alone or in paralleland can be synchronized or not with the audio and video of the computer.The microcontroller can be powered through the USB connection or with anexternal power supply in the present case with a power source.

Musical and Visual Stimuli

According to the previous references, the musical and visual stimulithat most effectively awaken emotions are pieces of classical music,melancholic music and videos of landscapes and natural life (201) and(212), respectively. There are many databases of images and videosavailable in multimedia, free or paid, that have been standardized andclassified by gender, author, era and others to be used in psychologicalor other applications. As an example there are WEB pages of music, operaand other genres and videos of natural landscapes, natural fractals andin general scenes of natural life (eg on www.youtube.com).

Multimedia is a technology that allows to integrate text, number,graphics, still or moving images, animation, sounds and videos and alsoallows navigation along different documents. It refers to any object orsystem that uses multiple means of physical or digital expression topresent or communicate information. The multimedia presentations can beviewed or heard on a stage, transmitted or played locally by means of amultimedia player, as understood by this invention. A transmission canbe live or recorded and with analog or digital technology and thedigital can be downloaded or transmitted in streaming.

By means of an example for the present invention one can use, amongothers, Windows Media Player (latest version 12), which is available forWindows 7, 8 and 10.

For Mac, Windows Media components can be downloaded so that QuickTimecan play Windows Media files. In addition you can use free VLC MediaPlayer which is a free and open source multimedia player, multiplatformand a framework that plays most multimedia files, as well as DVD, AudioCD, VCD and various transmission protocols.

Olfactory Stimuli

The odorants of this invention are presented through an essential oildiffuser (301) which is connected to a power source (302). The diffusercomprises a box with two holes which comprises two containers (303) and(304) among which are 2 resistors (305) and (306), in oil soaked in acotton (307) and (308). The oil is released through the holes in the boxwhen the resistance is heated, a process that is controlled from the PCthrough the Computational System.

For the control of the diffusers, a Wemos D1 mini card is used, which isresponsible for activating/deactivating it, either individually (onecontainer) or in parallel (both containers.) This is done from the PC bymeans of a relay module. With two channels (309) to allow the passage ofthe 24 V of a strip that in turn comes from the power source.

Vibrotactils

To present the vibrotactile stimuli an hydraulic circuit is used, closedand parallel, (400) that allows to massage with strokes and caresses andalso apply cold and vibrations, to the cutaneous surface of the upperpart of the patients' spine. The vibrations are caused by the turbulentflow generated by the peristaltic pump and the actuator, and transmittedto the tubes.

The circuit comprises 3 pumps, one peristaltic (402) moved by a steppermotor (DC, 24 V and 0.6 A) and 2 microdiaphragm pumps (403) and (404),(DC 12V and 1.5 A), flexible tubes (405), Y connections, a cooler withPeltier plates (406), a thermostat (407) and a temperature sensor (408),a micro mini three-way valve, two positions (401), normally closed (DC12V and 185 mA), and an hydraulic actuator (500), which has two 2-wayvalves, 2 positions, normally closed, at both sides of it (413) and(414).

In turn, the hydraulic circuit comprises two parallel hydraulichalf-circuits (409) and (410), functionally separated by the normallyclosed three-way solenoid valve (401) and wherein the operation of thefirst half-circuit (410) is controlled by a Arduino Nano microcontroller(A0), loaded with a program. The microcontroller simultaneously controlsthe activation of the two microdiaphragm solenoid pumps (403) and (404)and the opening of the three-way valve (401), through a 5V relay moduleand three channels, through a USB cable Android from the PC.

In short the operation of the first hydraulic half circuit (410)comprises the micro mini three-way solenoid valve, normally closed(401), which upon opening allows the flow to simultaneously go to thetwo microdiaphragm pumps (403) and (404), located in parallel and fedthrough two independent tubes (415) and (416), respectively, and whichare born from one in common (414), coming from the cooler through the3-way valve. The discharge of the fluid is done by two independent tubes(417) and (418) that are then joined together with a third one (419)that connects with the discharge tube of the peristaltic pump (420) andwherein the fluid that both microdiaphragm pumps drives through the tube(419), towards the cooler (406), is done to the rhythm of the music ofthe computer's multimedia player.

The Peltier plate cooler, with fans for each of them and water blocks,has a temperature sensor at its inlet, the readings of which can be seenon the PC screen. It also has an STC-1000 Digital Thermostat that ispowered by the 220V of the home electric network and that is regulatedindependently. As programmed in the thermostat, the set of 3 Peltiercells and their respective fans will be activated/deactivated. The setof Peltier cells and fans are powered from a power supply o 12V and 40A.

The functionality of this semicircuit is given by a sound sensor,capable of detecting an audible signal and converting it into a voltagesignal, which is read by the analog input of the microcontroller.

The program musical_source_code or loaded in the microcontroller,performs an analysis of these signals by separating the high and lowfrequencies to activate the microdiaphragm pumps (outputs D12 and D13).The microdiaphragm pumps are controlled through an Android USB cable anda three-channel relay module (one for the valve) from the PC.

On the other hand and additionally, sets of LEDs are activated, FIG. 2,(210) to accompany the sounds (outputs D12, D13, D4 and D9, D10 andD11). The activation signals of the pumps are received by the L298driver, which is responsible for activating and deactivating the pumps,giving them power from the 12 V power source.

The hydraulic semicircuit and LED lighting (210) works with any 2instruments that have different sound frequencies (e.g. drum and flute).In summary, the hydraulic circuit of this Invention is similar to thehydraulic circuit of a musical water source.

The second of the semicircuitos, has two modes of work, in the first(409) the flow has a unidirectional sense and in the second worksalternately bidirectional (409) and (409A), due to the movement ofadvance and retraction of the engine step by step of the peristalticpump, within a limited range, given by the lengths of its cylinder andplungers.

In the first mode of work, the micro mini three-way valve (401), sharedby the half-circuits (409) and (410), opens to the second half-circuit(409), while the peristaltic pump is activated (402), which is fedthrough the tube (413) and discharges its flow in the tube (420) thatconnects to the tube (419) from the 2 diaphragm pumps (403) and (404).While the three-way solenoid valve (401) is still open and theperistaltic pump is working, the flow recirculates into the 2ndhalf-circuit to the Peltier plate cooler (406) and with the hydraulicactuator open in that direction FIG. 6, (623).

The functionality of this working mode of the second hydraulicsemicircuit (409) is given by the Wemos D1 mini Card, mentioned above,which is responsible for controlling both the activation/deactivation ofthe peristaltic pump (402), as well as the speed of rotation of thesame, the execution times of the same, the cycle restart times and theoption to select random movements, speeds and times. This is done fromthe PC through an Android USB connection to the Wemos D1 mini card. Bypin D3 the card sends the necessary pulses directly to the DAT Input ofthe driver (Kamoer). The activation/deactivation is also carried out bymeans of a one-channel relay, which controls the opening of the solenoidvalve towards the peristaltic pump.

From the pin D6 of the Wemos Card, the activation/deactivation iscarried out by means of a relay, to allow the passage of the 24 Vnecessary for the supply of the driver (Kamoer) of the peristaltic pump.The 24 V comes from the power source 24V, 10 A, which shares the voltagewith the diffuser system by means of a power strip. One of theprotoboard of the driver allows to have more feeds of 5 v and theirrespective earths (GND) to power the relay modules and share the GNDlands with the driver (Kamoer) and the Wemos D1 mini card of the controlof diffusers.

So that the patient does not have to operate the hydraulic circuit bydefault, in terms of motions and times, and above all to introduceuncertainty in the sensory experiences experienced, a randomizationoption was enabled in the execution program of this working mode(activate/deactivate in speed and time ranges). The randomness that thepreviously indicated variables, movement, velocities and times take, isobtained through a Random Value Generator Program that is in the Randomlibrary:

https:/www.arduino.cc/reference/en/language/functions/random-numbers/random

Because Arduino is unable to create a true random number, the randomSeedlibrary allows you to place a variable, constant, or other controlfunction within the random function, and generate random numbers:

https://www.arduino.cc/reference/en/language/functions/random-numbers/randomseed/

As an alternative there are different programs that generate randomvariables, as an example in the following link you can find a programdeveloped in C++:

http://www.cplusplus.com/reference/cstdib/rand/

The 2nd mode of the 2nd semicircuit (409) is intended to make a slightcaress on the skin covering the upper part of the spine and is achievedthrough the work of an actuator (500), the 3-way solenoid valve and twopositions (401) the two 2-way valves and 2 positions (413) and (414) andthe stepper motor work of the peristaltic pump (402). The functionalityof the stepper motor, which operates bi-directionally at a predetermineddistance, is given by the Wemos D1 mini Card, mentioned above, which isresponsible for controlling the peristaltic pump (402) andsimultaneously activating/deactivating the mini micro three-way solenoidvalve and the two 2 ways solenoid valves, using a 5V and 4-channel relaymodule, via an Android USB cable from the PC.

The hydraulic actuator FIG. 5, (500) consists of a cylinder (501)partially lined in a fabric with hairs (502), which starting from acentral position (603) and with an inner ring at the center (506), moveslongitudinally and alternately in both directions and in the samedistance (504) or (505), on a pair of plungers that are fixed andhollow, water circulates inside them (507) and (608), and ending innozzles rings that point in opposite way (609) and (610), to bothdirections of the cylinder and discharging into the tubes of thehydraulic circuit (611) and (612) and wherein the actuator isalternately fed by water driven by the two solenoid valves, 2 ways andtwo positions (413) and (414), located on both of the cylinder. On theoutside of each of the plungers and at the same distance from its narrowends are located two rings (515) and 516) that can stop the advance ofthe cylinder towards both sides and where each of both pistons have attheir distal ends two inner rings (517) and (618) and grooves on theoutside to screw two tube connectors (519) and (520) that catch a mesh(521) and (522). The inner rings as well as the mesh are intended togenerate turbulent flows and the distance traveled by the actuator ineither direction must be equal to the angular distance that the motortravels step by step in the corresponding displacements.

The cycle is initiated when the 3-way solenoid valve (401) opens, theperistaltic pump (402) is activated, one of the two-way valves is opened(413) or (414) and drives the fluid to any of the nozzles (509) or(510), while it flows to the second nozzle, dragging the inner ring ofthe cylinder (506) to the fluid passage. The cycle is repeated in theopposite direction with the advance/return of the stepper motor of theperistaltic pump and the alternating opening of the 2-way solenoidvalves (413) and (414).

REFERENCES

UNITED STATES PATENTS 5,327,886 A August 1992 Chen-pang Chiu 6,425,764B1 June 1997 Ralph Lamson 2007/0225781 A1 March 2006 Saadat V. yEltherington L 2010/0312042 A1 December 2010 Anderson et al 7,927,294 B2April 2011 Kamimura et al 8,738,142 B2 May 2014 F. Palermo y C. CastelChris. 9,849,206 B1 November 2016 Ming Jen Hsiao OTHER PATENTS CN202822492 U CN March 2011 Chih-Kuo Liang 102010047757 B3 DE October 2010Bernd Basche WO 2006/084921 A1 Febuary 2005 Julio Ruiz et al CN205181749U November 2015

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1. A method of self-care for the treatment of patients of chronic painsthrough the induction of their own frissons or aesthetic chills, withtraditional sensory stimuli, comprising the following steps: Evaluatethe patient, through psychometric, sensory and physiological tests, thepsychological constructs, anxiety and fear, as well as the mood causedby the experience of pain, Evaluate by means of a self-report thephysical capabilities of the patient, To show the patient with theinstruments to measure blood pressure, heart rate and electricalconductance of the skin, informing them about the physiologicalparameters that should be achieved, To show the patient the stimuli hewill receive, according to their intensity, density, duration, volumeand frequency according to his emotional state, To show the patient awork station with a computer and its corresponding monitor, speakersand/or hearing aids and the way of reproducing multimedia files throughwhich the audiovisual stimuli will be presented, To exhibit to thepatient the closed hydraulic circuit of the present invention, by meansof which the tactile, vibrotactic and cold stimuli will be presented tohim, Have an operational computer program that provides services for theautomatic execution of application programs, as well as to act as theenvironment of the application in which the program is executed, Inducefrissons in the patient their own frissons by means of the sensorytraditional stimuli, in order to alter the behavior, the functionalityof the senses, the reflexes and/or their physiological parameters, Toshow the patient the stimuli in with multisensory way; where differenttechniques are used to provide a set of sensations and specific stimuli,to the patient, To show the stimuli to the patient in a multimodal way,where sensations from different sensory sources are integrated,Synchronize the presentation of the stimuli, in relation to time andmovement, as a function of the rhythm of the music, Obtain aself-evaluation of the patient's about his physiological parameters;blood pressure, heart rate and electrical conductance, in addition to aself-report on his physical abilities,
 2. The method according to claim1, wherein the assessment of pain and physical capabilities of thepatient, comprises the intensity, character, location, irradiation,time, associated factors, implications and meaning.
 3. The methodaccording to claim 1, wherein the sensory evaluation contemplatesinvoking, provoking, measuring, analyzing and interpreting the reactionsto the characteristics possessed by the different types of stimuli, towhich the patient is subjected.
 4. The method according to claim 1,wherein the evaluation of the anxiety and/or fear construct is carriedout through, although not in an excluding manner, the followingcognitive skis: divided attention, selective attention, sustainedattention, numerical reasoning, visual exploration, flexibility,inhibition, spatial memory, contextual memory, short-term memory,working memory, visuospatial memory, short-term visual memory, auditoryperception, spatial perception, visual perception, planning, reasoning,problem solving, speed reaction time and processing speed.
 5. The methodaccording to claim 1, wherein the various stimuli are chemical,electrochemical, physical, biological, physiological, vibratory,pressure and tension, movement, temperature, liquid, gaseous, light,sound, structural, psychological, emotional, sensory, external,internal, conditioned, unconditioned, motivational or subliminal.
 6. Themethod according to claim 1, wherein the musical stimuli compriseclassical music, opera, film music, ballads and melancholic melodies,military marches, bossa-nova, sweeps of scale and appogments, and wherethe sound comes from the speakers that are in the work station (FIG. 2)and (202).
 7. The method according to claim 1, wherein the visualstimuli comprise images patient's of relatives, of nature; landscapes,rivers, seas, waves, forests and gardens, and where the images come fromthe monitor that Is in the work station (FIG. 2) (211).
 8. The methodaccording to claim 1, wherein the closed hydraulic circuit (FIG. 4)comprises 3 hydraulic pumps, a peristaltic one (401) and 2 diaphragm(403) and (404), hoses and connections, 1 hydraulic actuator (500), 1cooler (406), 1 temperature sensor (408), 1 thermostat (407) and 3solenoid valves normally closed; one of them of 3 ways (401) and 2positions and 2 of 2 ways and 2 positions (413) and (414).
 9. The methodaccording to claim 8, wherein the closed hydraulic circuit is deployedaround the torso of the patient in bandolier, from shoulder to oppositehip (FIG. 1A) and (FIG. 18) and where the 3 pumps, the cooler, thetemperature sensor, the thermostat and the 3-way solenoid valve are in acontainer (102), while part of the tube (405), the actuator (FIG. 5) and(600) and the 2-way solenoids valves are rubbing the area of the skinthat covers the upper part of the spine and in which the flexible tubeis supported to the skin by means of double suction cups (101), loose soas to maintain the vibration of the tube.
 10. The method according toclaim 8, wherein the Peltier plate moduler (FIG. 4) and (406), with fansin each one of them and water blocks, has a temperature sensor at theinlet (408), whose readings can be seen on the screen of the PC and alsohas a digital thermostat STC-1000 (407), which is powered by the 220Vhome electrical power network and which is regulated in an independentway, and depending of that adjustment it will activate/deactivate theset of 3 Peltier cells and their respective fans and where the Peltiercells and fans are fed from a power source of 12V and 40 A.
 11. Themethod according to claim 8, wherein the peristaltic pump (402) and theactuator of the hydraulic circuit (FIG. 5) and (500), cause a turbulentflow and vibrations that are transmitted to the walls of the tubes andin that way they can present the vibrotactile stimuli to the area of theskin that covers the upper part of the spine.
 12. The method accordingto claim 8, wherein the operation of the hydraulic circuit that allowsthe presentation of tactile, vibro-tactile and cold stimuli that arecontrolled through a computer system on the computer of the workstation.
 13. The method according to claim 8, wherein the hydrauliccircuit that allows the application of tactile, vibrotactile and coldstimuli can be operated randomly from the PC in terms of time andvelocity of the peristaltic pump.
 14. The method according to claim 8,wherein the hydraulic circuit comprises 2 parallel half-circuits FIG. 4,(409) and (410), functionally separated by the closed 3-way solenoidvalve and wherein the operation of the first half-circuit (410) iscontrolled by an Arduino Nano microcontroller (AD), loaded with aprogram and wherein said microcontroller simultaneously controls theopening of the three-way solenoid valve and the activation of the 2microdiaphragm solenoid pumps, by means of a 5V relay module and threechannels, through an Android USB cable from the PC.
 15. The methodaccording to claim 8, wherein the discharge of the two diaphragm pumpsis done by two independent tubes (FIG. 4) (417) and (418) which are thenjoined with a third (419). that connects to the discharge tube of theperistaltic pump and where the fluid that both microdiaphragm pumpsdrive through the tube (420), towards the cooler, is made to the rhythmof the music of the computer's multimedia player, just like theoperation of the two LED lamps in the work station (FIG. 2) and (210).16. The method according to claim 8, wherein the functionality of thissemicircuit (410) is given by a sound sensor, capable of detectingaudible signals and convert them into voltage signals, which are read bythe analog input of the microcontroller and where the programcode_musical_source or loaded in it, performs an analysis of thesesignals by separating the high and low frequencies to activate themicrodiaphragm pumps (outputs D12 and D13) and wherein themicrodiaphragm pumps are controlled through a cable USB Android and arelay module of 3 channels (one per valve) through the PC and where thediaphragm pumps of the hydraulic semicircuit (403) and (404)respectively, and the LED lamps work with at least 2 instruments thathave different sound frequency.
 17. The method according to claim 8,wherein the second semicircuit has two modes of operation, in the first(409) the flow has a unidirectional direction and in the second it worksalternately in a bidirectional way (409) and (409A), due to the forwardand backward movement of the stepper motor of the peristaltic pump,within a limited range, given by the lengths of the cylinder and pistonsof the actuator.
 18. The method according to claim 8, wherein in thefirst working mode the three-way micro mini-valve (401), shared by thehalf-circuits (409) and (410), opens to the second half-circuit (409).),while activating the peristaltic pump, which is fed through the tube(413) and discharges its flow into the tube (420) that connects to thetube (419) from the 2 diaphragm pumps, while the valve 3-way solenoidcontinues open and the peristaltic pump is working, the flowrecirculates into the 2nd semi-circuit to the Peltier plate cooler andwith the hydraulic actuator open in that direction (FIG. 5) and (523).19. The method according to claim 8, wherein the functionality of thisfirst working mode of the 2nd hydraulic half-circuit (409), is given bythe Wemos D1 mini card, above mentioned that is responsible forcontrolling both the activation/deactivation of the peristaltic pump, aswell as its rotation speed, execution times, cycle restart times and theoption to select movements, speeds and random times and where this isdone through the PC through a USB Android connection to the Wemos D1mini card and where by the pin D3 the card sends the necessary pulsesdirectly to the DAT input of the driver and where theactivation/deactivation is also carried out, by means of a relay of achannel, which controls the opening of the solenoid valve towards theperistaltic pump.
 20. The method according to claim 8, wherein the 2ndmode of operation of the 2nd semicircuit (409) (409A) is intended tomake a slight caress on the skin covering the upper part of the spineand that is achieved through the work of an actuator (FIG. 5) and (500),the 3-way solenoid valve and two positions and the 2-way and twopositions solenoid valves, with the forward/reverse work of the steppermotor of the peristaltic pump.
 21. The method according to claim 8,wherein the stepper motor functionality, which works bidirectionally ata predetermined distance, is given by the Wemos D1 mini card, abovementioned, that controls the peristaltic pump and simultaneously alsothe activation/deactivation of the mini micro solenoid valve of threeways and of the two solenoid valves of two ways, by means of a module ofrelays of 5V and 4 channels, through an USB cable Android from the PC.22. The method according to claim 8, wherein the hydraulic actuator FIG.6, (500) consists of a cylinder (501) partially lined in faux fur fabric(502) that touches the skin, and that starting from a central position(503) and with a ring internal to the center (606), moves longitudinallyand alternately in both directions and in the same distance (504) or(505), on a pair of plungers that are fixed and are hollow, watercirculates inside it (507) and (608), and ending in ringed nozzlespointing in opposite directions (609) and (510), towards both ends ofthe cylinder and discharging into the hydraulic circuit tubes (511) and(512) and wherein the actuator is alternately powered by water driven bythe two solenoid valves, two-way and two positions (413) and (414),located on the sides of the cylinder and wherein on the outside of eachof the plunger, at equal distance from their narrow ends, are locatedtwo rings (515) and (516) that act as stops and can brake the advance ofthe cylinder to both sides and where each of both plungers have twoinner rings (517) and (518) threaded ends on the outside to screw twotube connectors (19) and (620) that trap a mesh (521) and (622).
 23. Themethod according to claim 8, wherein by geometry the inner rings of theplungers (517) and (518), as well as the mesh (621) and (522), areintended to generate turbulent flows and wherein the distance traveledby the actuator in either direction must be equal to the angulardistance traveled by the motor step by step in the correspondingdisplacements.
 24. The method according to claim 1 wherein the odorantsof this invention are presented through an essential oil diffuser (FIG.3) and (301) which is connected to a power source (302) and wherein thediffuser comprises a box with two orifices which comprises twocontainers (303) and (304), comprising 2 resistances, one in each, (305)and (306) and cotton soaked in oil (307) and (308)) and where the oil isreleased, through the holes of the box, when the resistances heats up, aprocess that is controlled from the PC by the computational system andwherein a Wemos D1 mini card is used to control the diffusers which isresponsible for activating/deactivating them, either individually, inone container, or in parallel with two containers, which is done fromthe PC through a two-channel relay module (309) to allow the passage ofthe 24 V of an electric strip that in turn comes from the source ofpower.